Ocular surgical work tip adapter

ABSTRACT

An adapter for a surgical hand piece with a single lumen work tip converts the handpiece to infusion/aspiration (I/A) cleanup of lens epithelial cells in the capsular bag of the eye a patient after phacoemulsification. The adapter is in the form of a sleeve whose proximal end is to be joined to the distal end of work tip. The sleeve also has at least one aspiration hole located toward the distal end of the sleeve.

TECHNICAL FIELD

The present invention is generally directed to hand pieces for ocularsurgery, particularly for the removal of cataracts from the eye of apatient by phacoemulsification.

BACKGROUND OF THE INVENTION

The use of instruments in ocular surgical applications is well known.One widely used type of instrument is an ultrasonic hand piece that isused in ophthalmic applications, such as in the removal of cataractsfrom the eye by phacoemulsification.

FIG. 1 depicts one such type of prior art ultrasonic hand piece as shownin U.S. Pat. No. 4,504,264 of Kelman. This hand piece has a housing 10of, for example, plastic or metal, within which is supported atransducer means 11 for generating mechanical vibrations upon excitationwith an alternating-current electrical signal. The transducer 11 isshown as a magnetostrictive transducer with an electrical coil 12 woundabout a stack of metal laminations so that longitudinal mechanicalvibrations are produced. The transducer can also be of the piezoelectrictype. There is a connecting body 16 of, for example, titanium, having areduced diameter distal end portion, which also can be an attachedseparate portion. The connecting body forms an acoustic impedancetransformer for conveying the longitudinal vibrations of the transducer11 for application to an operative tool or working tip 14 connected tothe distal end of the connecting body 16.

The work tip 14 is connected, such as by a screw thread, to the narroweddistal end of the connecting body 16 so as to be coupled to thetransducer 11. As a result, the work tip is longitudinally vibrated bythe transducer. The working tip 14 is an elongated, hollow tip of asuitable metal, such as titanium, that is capable of supportingultrasonic vibrations. It has a distal end of a desired shape to beplaced against the tissue to be removed. The work tip 14 has a baseportion 15 in threaded engagement with the distal end of the connectingbody 16. The tip 14 can be interchanged by use of the screw threads.

The distal end of the tip 14 is shown surrounded by a sleeve 17, whichmay be made of a material such as silicone, whose proximal end 18 issupported in threaded engagement on a reduced diameter end of thehousing 10. If desired, the proximal end of sleeve 17 can be engagedmore proximally along the length of the housing 10. The connecting body16 has two elastomeric O-rings 19, 20 on its outer surface. Theseprovide a fluid-tight seal between the connecting body 16 and thetransducer means 11. A plurality of screws 51 are shown disposed aroundthe axis of the housing 10 for preventing longitudinal displacement(other than vibration) or rotational movement of the vibratory structurewithin the housing and also for radial centering of the vibratorystructure within the housing. Other types of conventional mountingarrangements can be used.

The hand piece also illustratively has electrical input terminals 40, 41for applying a suitable electrical signal to the magnetostrictivetransducer 11. Cooling water is shown provided inside the housing 10from an inlet 42 to an outlet 43 and within a chamber between O-ring 19and a grommet 50 for circulation around the transducer. This is notalways necessary and is not used in most present day hand pieces.

The sleeve 17 around the tip 14 forms a first fluid passage 21 betweenthe tip 14 and the sleeve for an infusion/irrigation fluid. An inlet 22is provided on the housing or sleeve distally of the O-ring 20 forsupplying the irrigation fluid to the passage 21 from a fluid supply,e.g., a bag of saline solution (not shown).

A passage 23 is formed through the connecting body 16 that is incommunication with a central passage 25 of the work tip 14. An outlet 24on the housing or sleeve receives a suction (aspiration) force that isapplied to the passage 23 in the connecting body and the central passage25 in the work tip. A chamber 31 is formed between the spaced O-rings19, 20 on the body 16 and the housing 10, with which the aspirationforce from outlet 24 communicates. Thus the aspiration force is from thesource (e.g., a suction pump not shown), into the chamber 31 between theO-rings, through the passage 23 in the connecting body and the passage25 in the work tip 14. Tissue that is emulsified by the work tip isaspirated from the operating site by the aspiration flow force. Inparticular, saline solution introduced into the eye through fluidpassage 21 and tissue displaced by the vibration force of the tip 14, isdrawn into the distal end of passage 25 and passes out of the hand piecethrough outlet 24. It should be noted that passage 25 is locatedconcentrically within passage 21.

As indicated, other apparatus (not shown) for use with the hand pieceinclude the suction pump for producing the aspiration fluid (suction),the treatment fluid supply (infusion/irrigation fluid, such as a salineliquid), an oscillator for applying an electrical signal to thevibratory structure and control apparatus therefore. All of these are ofconventional construction.

Considering now the operation of the hand piece of FIG. 1. When anelectrical signal having a frequency of, for example, 40,000cycles/second is applied to the coil 12 around the magnetostrictivetransducer 11, the transducer 11 vibrates longitudinally at 40,000cycles per second, thereby vibrating the connecting bodies 13, 16 andthe work tip 14. Treatment fluid is supplied through inlet 22 and fluidpassage 21 to bathe the tissue in the operating site region around theworking tip 14. Suction force is applied through inlet 24 and passage 23to the working tip 14 passage 25 to withdraw the tissue fragmented bythe work tip along with some of the treatment fluid.

Instruments of the type described above are often used in cataractsurgery in which the eye lens is removed from the eye capsule and anintra-ocular lens (IOL) is then implanted. In such a procedure beforethe IOL is implanted it has been found to be desirable to cleanup lenssubstance and lens epithelial cells (LEC's) in the capsular bag of theeye and to remove them. Doing this procedure provides a more stable andlong-term fixation for certain types of IOL's in the capsular bag. Onemanner of accomplishing the cleanup is to use a combination of low forceirrigation of the capsular bag interior with a liquid together with theapplication of low power ultrasonic energy. This dislodges the unwantedcells and substances without damage to the capsular bag. Further, thismaterial can be removed from the capsular bag by the aspiration fluidflow, which also may be reduced in pressure to avoid damage.

In a cleanup procedure it is advantageous if the flow of the irrigationliquid can be made more directional than would be possible using thehand piece with the outer sleeve through which the liquid flows andexits from around the work tip that produces the ultrasonic energy. Itis also better if the aspiration force is lower. As a result, typicallya different tip from the one illustrated in FIG. 1, which breaks up thetissue, is used for the cleanup. In fact a completely differentinstrument called an irrigation or infusion/aspiration (I/A) instrumentis often used for this purpose. Such an instrument 90 is illustrated inFIG. 2. It has a handle 91 at one end and a work tip 92 at the otherend. An enlarged view of the work tip is shown in FIG. 3. The I/Ainstrument work tip has concentric infusion and aspiration lumens, andtypically has no ultrasonic vibration capability. The infusion fluidenters the work tip at opening 93 and is in an outer concentric lumen sothat its flow surrounds the distal part of lumen 95 of the work tip. Theaspirated tissue enters a small hole 94 in the distal part and iswithdrawn through lumen 95. Thus, when the phacoemulsification has beencompleted and cleanup is to be started, the surgeon must remove thephacoemulsification tool from the eye. Then the surgeon removes thefirst or phacoemulsification work tip, replaces it with a differentcleanup work tip and then inserts the new work tip or a separate I/Atool 90 is inserted in to the eye. This second insertion into the eyeincreases the possibilities of infection and trauma. Also, the I/A toolhas a disadvantage in that the surgeon would have to keep inserting andwithdrawing the ultrasonic work tip and the I/A tool from the eye as theprocess is completed, because the surgeon cannot be sure that all of thetissue has be broken up until the cleanup process has begun. As aresult, this would also subject the patient to the increasedpossibilities of infection and trauma.

As shown in the present inventor's own U.S. Pat. No. 8,641,658, thesurgical instrument may be provided with dual lumens in tubes 132, 134,each of which can alternatively be used for aspiration of emulsifiedtissue and irrigation of the surgical site. FIG. 4 shows a work tip 130that can be connected to an ultrasonic energy source 102 of a hand pieceby means of a connecting body 204. Two fluid passages 120 and 180 foraspiration or irrigation fluid pass through the connecting body 204. Forexample the proximal end of passage 120 can be in communication with theirrigation fluid input of the supply line 124 and the proximal end ofpassage 180 can be in communication with the aspiration fluid of thesupply line 164. The distal ends of the two passages 120 and 180terminate at the distal end of the connecting body 204.

There are threads 182 around the connecting body distal end. A hub 190is around the proximal ends of the work tip tubes 132 and 134, which arebent so that the proximal ends of their lumens are parallel to thedistal ends of the connecting body passages 120 and 180. A collar 194with internal threads on its open end has its flange end rotatablymounted in a groove 192 in the hub 190. There are mating index pieces,such as mating grooves and ribs or pins (not shown), on the opposingfaces of the connecting body 204 distal end and the hub 190 so that theproximal end of the lumen of tube 132 will be aligned with the distalend of connecting body passage 120 and the proximal end of the lumen oftube 134 aligned with the distal end of passage 180.

When the tubes and connecting body are properly aligned the collar 194is tightened on the connecting body threads 182 and the lumens at theproximal ends of tubes 132 and 134 will be brought into fluidcommunication with the distal ends of the connecting body passages 120and 180. O-rings 193 are provided in the connecting body at the distalends of passages 120 and 180 to make the communications fluid tight.

Both of the tubes 132 and 134 receive the ultrasonic energy from thesource 102 (not shown). A valve (not shown) can be used with the handpiece of FIG. 4 to switch the fluid flow from the sources 124 and 164 tothe lumens of tubes 132 and 134 of the integrated work tip. Since bothtubes 132 and 134 receive ultrasonic energy the emulsification of tissueand its aspiration can take place through either one in addition to eachtube being able to supply irrigation liquid through the different typesand shapes of openings at the distal ends of the tubes.

The work tip can be used with only an irrigation/aspiration (I/A)function by turning off the source of ultrasonic energy and onlysupplying the aspiration and irrigation fluids. Thus, the sameinstrument can be used for the phacoemulsification function whileperforming irrigation and aspiration as an operation takes place andalso only for I/A functions (no or minimal ultrasonic energy is used)useful for cleaning the capsular bag as described above. This eliminatesthe need for the surgeon changing instruments and also provides thesurgeon with a work tip having two tubes with different shape openingsavailable for both aspiration and irrigation.

Only one of the tubes, e.g., 134, can be used as an I/A work tip. In theoval shaped openings 165 along the tube length can be used alone in theeye capsular bag for the substance and cell cleanup procedure describedabove. The oval shaped openings 165 allow for both good dispersion ofthe irrigation fluid or a large area for aspiration of cells andsubstances dislodged by the irrigation liquid.

While the work tip of U.S. Pat. No. 8,641,658 can use its dual lumentubes for phacoemulsification and for I/A cleanup thereafter, it wouldbe advantageous if these functions could be provided to a single axialwork tip as shown in FIG. 1. In addition, it would be beneficial ifphacoemulsification instruments with single lumens could have theiroperation varied without withdrawing the instrument from the eye and/ordiverting the surgeon's attention from the operating site. This wouldreduce the chances of infection and trauma.

SUMMARY OF THE INVENTION

In accordance with the invention a surgical hand piece is provided thatcan perform all of the functions of emulsification of tissue and othersubstances by ultrasonic energy and aspiration of such tissue andsubstances, as well as reduced pressure irrigation and aspiration of asite that is being worked on in order to clean up the site. The handpiece can be used for surgery on appropriate tissue throughout the body,e.g., neurological tissue and ocular tissue.

The invention provides a surgical phacoemulsification hand piece thathas a single axial work tip that is concentric to a surroundingirrigation tube. Thus it can be like the prior art work tip in FIG. 1 oran improved work tip as shown in the present inventor's U.S. PatentApplication Publication No. US 2015/0025451 A1, which is incorporatedherein by reference in its entirety. The improved design has adisposable work tip so that the entire handpiece need not be sterilizedbetween operations.

During a phacoemulsification procedure, an ultrasonic source in the handpiece causes the single work tip to vibrate and to remove cataracttissue. However, when this is complete, the ultrasonic vibration isended and an adapter converts the work tip for I/A so that it is adaptedto clean up of the capsular bag by changing the configuration of theaspiration opening.

In one embodiment the work tip is removed from the eye and an adapter isplaced over it so as to modify the opening. In a second embodiment theadapter is fixed to the work tip and its configuration is changed whenI/A clean up is desired. With the second embodiment the adapter can bechanged without removing the work tip from the eye. Also, the surgeoncan selected one of a variety of adapters such that the aspirationpattern during the cleanup can be selected to suit the circumstances.These different patterns can be achieved without the surgeon having toremove the I/A tool from the eye.

The principles of the invention have numerous advantages. For example,the invention allows a phacoemulsification tool to be converted with anadapter to serve as an I/A clean up tool. Further, an embodiment of theinvention allows for the elimination of the need for the surgeon toremove an ultrasonically-driven work tip from the operating site, suchas the eye, and to insert a separate work tip or tips having 1/A cleanupcapability, in order to perform special procedures, such as cortical andlens epithelial cell cleanup. Further, if an I/A tool is used accordingto the present invention, clean up can be commenced without the surgeonhaving to divert his attention from the eye.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects and advantages of the present inventionwill become more apparent when considered in connection with thefollowing detailed description and appended drawings in which likedesignations denote like elements in the various views, and wherein:

FIG. 1 is a view in partial cross-section of a prior art type ofsurgical hand piece;

FIG. 2. is a partial cross-sectional view of a prior artirrigation/aspiration instrument with a removable tip;

FIG. 3 is a partial cross-sectional enlarged view of the prior art tipfor the infusion/aspiration instrument of FIG. 2;

FIG. 4 is cross-sectional view of a prior art dual lumen surgical handpiece;

FIG. 5A is a cross-sectional view of a first embodiment of a surgicalhand piece with a single axial work tip and an adapter for I/A clean upof a capsular bag of the eye according to the present invention, andFIG. 5B is an enlarged view of the attachment of the adapter to the worktip;

FIG. 6 is an enlarged cross-sectional view of a second embodiment of awork tip and I/A clean up adapter according to the present invention;

FIGS. 7A and 7B are a cross-sectional view and an enlargedcross-sectional view, respectively, of a third embodiment of a work tipand I/A clean up adapter according to the present invention;

FIGS. 8A and 8B are a cross-sectional view and an enlargedcross-sectional view, respectively, of a fourth embodiment of a work tipand I/A clean up adapter according to the present invention;

FIGS. 9A and 9B are a cross-sectional view and an enlargedcross-sectional view, respectively, of a fifth embodiment of a work tipand I/A clean up adapter according to the present invention;

FIG. 10 is a cross-sectional view of a sixth embodiment of a work tipand I/A clean up adapter according to the present invention;

FIG. 11 is a perspective view of a hand piece with a mechanism forsliding a sleeve to change the function of an adapter according to thepresent invention without removing the work tip from the eye of thepatient;

FIG. 12A is a front cross sectional view of an adapter in the form of ahinged sleeve according to the present invention mounted on a work tipin an open position, FIG. 12B is a front cross sectional view of theadapter of FIG. 12A with the hinge closed, FIG. 12C is a schematic sideview of the adapter of FIG. 12A with the hinge open and FIG. 12D is aschematic side view of the adapter of FIG. 12B with the hinge closed;

FIG. 13A is a cross sectional elevation view of an adapter in the formof a flexible folding sleeve according to the present invention mountedon a work tip in an open position, FIG. 13B is a plan view of theadapter of FIG. 13A, FIG. 13C is a cross sectional elevation view of theadapter of FIG. 13A with the sleeve moved upward to partially close theend of the work piece, FIG. 13D is a plan view of FIG. 13C, FIG. 13E isa cross sectional elevation view of the adapter of FIG. 13A with thesleeve moved upward to nearly completely close the end of the workpiece, and FIG. 13F is a plan view of FIG. 13E; and

FIG. 14A is a cross-sectional view of a dual lumen work tip with anadapter according the present invention installed at the distal end, andFIG. 14B shows a perspective view of the distal end of the work tip andthe adapter prior to installation over the distal end.

DETAILED DESCRIPTION OF THE INVENTION

FIG. 5A shows an embodiment of a handpiece disclosed in the presentinventor's US Patent Application Publication US 2015/0025451 A1, whichis incorporated herein by reference in its entirety. This handpiece isshown receiving an adapter 230 according to the present invention. Thehandpiece uses a number of the components of the prior art type ofhandpiece described above with respect to FIG. 1. The source of theelectro-mechanical energy is shown schematically as transducer 11. Thistransducer can be either the electromagnetic type or the piezoelectriccrystal type. It is preferred, and is conventional, that the outputpower of the transducer 11 be controlled by electrical signals deliveredover wires 40, 41 from a control unit (not shown). These signals allowthe ultrasonic power at the work tip distal end 146 to be varied asneeded by the surgeon.

Connected to the transducer 11 is the connecting body 16. Both thetransducer 11 and connecting body 16 are provided in a housing 10.Although not shown for the sake of clarity, the transducer andconnecting body are suspended within housing 10 so as to permit thelongitudinal vibration of the transducer and connecting body to occurrelative to the housing. For example, the O-rings 19 and 20 shown inFIG. 1 are spaced apart around the connecting body 16 and engage theinner surface of the housing 10.

The work tip 14 has an opening 143 that leads to an axial channel 25extending from the opening to an enlarged hub 140 at the proximal end ofthe work tip. Within the hub 140 there is a radial channel 142 thatextends from the axial channel 25 to the outer surface of the hub. Whilethe radial channel 142 is shown at a right angle to the axial channel,in fact it can be at any convenient angle that allows it to extend fromthe axial channel to the outer surface of the hub. A threaded connector15 extends from the proximal end of the hub and engages the distal endof the connecting body 16.

A sleeve 17, which may advantageously be made of silicone, is providedwith a funnel shape so that its proximal end 18 is large enough toencompass the enlarged hub, and still leave space for chamber 117between the outer surface of the hub and the inner surface of thesleeve. The distal end of the sleeve tapers down around the portion 144of the work tip beyond the hub, which extends to a flared portion 146 ofthe work tip which is at the operating or distal end. As a result theaxial channel has a larger diameter at the distal end that tapers downto a smaller diameter as it extends through the work tip into the hub140. The sleeve stops short of the portion 146. The proximal end 18 ofsleeve 17 makes a threaded connection with the body 10. Although notshown, a sterile sheet may be fastened to the end 18 and draped over thehousing to avoid contaminating the housing during procedures.

Sleeve 17 has a first external connector 22 on its outer surface that isin fluid communication with the chamber 117. A tube 210 carryingirrigation fluid may be connected to connector 22 in order to supplyirrigation fluid to chamber 117. Fluid in chamber 117 may flow betweenthe outer surface of work tip portion 144 and the inner surface ofsleeve 17 in a channel 21 so as to exit the handpiece just short of theflared portion 146 of the work tip, i.e., at the site of the operationof the handpiece on the patient's tissue. Sleeve 17 also has a secondexternal connector 24 on its outer surface. In the drawing thisconnector is shown as being on the opposite side of the sleeve from theconnector 22. However, in practice this connector can be at anyconvenient location on the sleeve. A seal piece 148, e.g., an O-ring orother form of seal, connects the radial channel 142 to the secondconnector 24. A tube 220 provides a suction force (e.g., from aperistaltic aspiration pump) on connector 24. This causes tissue to bedrawn into the opening 143 at portion 146 of the work tip, to travel upthe axial channel 25 and into the radial channel 142, to pass throughthe O-ring 148 and the connector 24, and finally to be drawn throughtube 220 to the aspiration pump.

In operation the handpiece of FIG. 5A operates similar to otherphacoemulsification handpieces. Electrical energy is applied throughwires 40, 41, which causes the ultrasonic transducer to vibrate axiallyat ultrasonic frequencies. The mechanical axial force is transmitted tothe connecting body 16, which in turn transmits it to the work tip 14.When the end 146 of the work tip is placed in contact with tissue, e.g.,a cataract, the vibration causes the tissue to break up. While this isoccurring, irrigation fluid, e.g., saline solution, passes from asource, through tube 210 and connector 22 into chamber 117, alongchannel 21 and is deposited at the operating site as shown by the arrows230 in FIG. 5B. At the same time the fragmented tissue is drawn into theopening 143 in portion 146 as shown by arrow 240 in FIG. 5A. It passesup the axial channel 25 into the radial channel 142, through the O-ring148 and connector 24 to tube 220.

When the handpiece is used in its intended fashion and the procedure isover, the handpieces can be quickly readied for use on another patientwithout the need for sterilization. In particular, the tubes 210, 220are disconnected and discarded. Then the sleeve 17 with its sterilesheet at proximal end 18 is unthreaded from the housing 10 and theconnecting body 16. Next, the work tip 14 has its threaded connector 15loosened from connecting body 16. Then the working tip and sleeve 17 arediscarded. The work tip and sleeve, as well as each of the sets of tubesare replaced with clean, pre-sterilized parts, and the handpiece isready for the next use. This is possible because the only parts of thehandpiece that come into contact with the aspiration fluid from thepatient are the work tip, sleeve and the interior of tube 220. Exceptfor the work tip, the other disposable parts can be made of inexpensivematerials, e.g., silicone. Thus, the cost of the replacement parts isnot very great.

The work tip of the present invention can be used with only aninfusion/aspiration (1/A) function. That is, the source of ultrasonicenergy can be turned off or reduced. The aspiration andinfusion/irrigation fluids are supplied to the tubes 210 and 220; but,the aspiration force can be lowered, e.g., from 500 mm Hg to 5-10 mm Hgduring the cleaning operation so that the posterior capsule tissue atthe back of the eye is not drawn into the tube. The irrigation fluidforce can also be lowered. However, it is preferable to utilize smalleropenings than that of the work tip at 146. One way to accomplish this isto withdraw the work tip from the eye of the patient and to place anadapter 230 over the end of the work tip.

The adapter 230 as best shown in FIG. 5B is a closed end tube with asmall opening 234 or series of openings. During clean up, the remainingtissue (i.e., lens epithelial cells) is aspirated through this smallhole while irrigation fluid continues to be applied to the site fromchannel 21. The adapter can be made of metal or soft plastic. If it ismade of metal, a soft plastic coating is preferred to avoid damage tothe capsular bag of the eye.

The cylindrical proximal end 231 of the adapter is slid into the flaredpart 146 of the work tip until protrusions 232 on its outer surfaceengage in recesses 145 within flared part 146. This connectionestablishes locking engagement between the adapter 230 and work tip 14.This engagement is aided by the suction force within the work tip.Distal end 233 of the adapter is made thicker than the end 231 andsurrounds opening 234. The end 231 is also made smooth so as to provideprotection against harm to the capsular bag.

FIG. 6 shows an arrangement similar to FIG. 5B, but instead ofprotrusions 232 and recesses 145, the adapter 230 is fastened to theflared part 146 of the work tip by a protrusion 241 engaging a slot 242in the flared part 146.

The adapter 230 of FIG. 7A is made larger than the flared part 146 sothat the adapter extends over the flared part when installed on the worktip. The flared part has external threads 245 as shown in FIG. 7B whichengage internal threads 247 on the adapter 230. This forms theengagement between these parts.

The adapter 230 of FIGS. 8A and 8B is made flexible and slightly largerthan the flared part 146. The ends 235 of the adapter bend inwardly.When the adapter is installed it is slid over the flared part, whichcauses at least the ends to expand outwardly. Once the adapter is nearlyover the flared part, the ends 235 of the adapter snap into detents 149in the exterior surface of the work tip to hold the adapter on the worktip. Note that the adapters shown in FIGS. 7 and 8 do not have theenlarged distal surface 233. Depending on the size (diameter) of theadapter, the surface 233 may not be necessary to protect the capsularbag.

The adapter of FIGS. 9A and 9B resemble that of FIG. 5B in that it issmaller in diameter than the flared part and slides within it. However,instead of protrusions and recesses, this design relies on a press fitbetween the parts and the aspiration force to hold the adapter on thework tip. Also in this design, the expanded distal part 233 of theadapter is designed to have a thickness that matches that of the flaredpart so that when joined the two parts have a smooth connection line.

The embodiment of FIG. 10 is the opposite of that in FIG. 7. Inparticular, the adapter has threads 248 on a reduced diameter portion ofits proximal end 231, which end slides within the flared part 146. Thethreads 248 of the adapter engage threads 148 on the interior of theflared part.

In each of the designs of FIGS. 5-10, the aspiration opening 234 hasbeen shown as a simple hole. However, it should be understood thatopening 234 may be a plurality of openings in different patterns, ofdifferent sizes and with different shapes. The surgeon will select theadapter to best meet the conditions that present during the surgery.

With the designs of FIGS. 5-10, it is necessary for the surgeon toremove the work tip from the eye of the patient in order to make use ofany particular adapter. This of course takes time away from theprocedure, exposes the surgical site to infection and/or trauma. Thus,it would be advantageous to be able to engage a clean-up adapter withouthaving to remove the work tip form the eye. Such a design is shown inFIG. 11.

FIG. 11 shows a hand piece with a work tip 14 at the end. Either theirrigation sleeve 17 or an additional sleeve 320 located outside theirrigation sleeve can slide along the work tip. In the embodiment ofFIG. 11, the sliding of the sleeve 320 is achieved with a mechanism 300attached to the exterior of the hand piece. Mechanism 300 includes afinger portion 302. The finger portion is connected to a linear portion304 that runs along the exterior surface of the hand piece and isslidable with respect to that surface. A slanted portion 306 extendsfrom the linear portion down to the work tip and then connects to sleeve320. All of the portions of mechanism 300 are slidable with respect tothe hand piece. The mechanism 300 is preferably located on the handpiece such that it does not interfere with the irrigation and aspirationtubes and is close to the body of the hand piece. Also, preferably, thepieces 302, 304, 306 and 320 are flexibly joined to each other so thatduring the sliding motion, they do not extend way from the body of thework piece. Depending on the shape of the hand piece, additional orfewer sections of the mechanism 300 may be used. Also, a sterile sheet315 is shown attached to the hub of the work tip. A portion or portionsof the mechanism would penetrate the sterile sheet, if used, to reachthe finger portion 302 on the housing.

When the surgeon completes the emulsification of the cataract and wantsto start to clean up the remaining tissue, he or she turns off theultrasonic energy or reduces it, reduces the force of the irrigation andaspiration fluid flows and uses his or her finger to slide the sleeve320 forward. This can all be accomplished without removing the work tipfrom the surgical site within the patient's eye. In general the effectof sliding the adapter is to cause to openings in the work tip to bereconfigured for I/A clean up.

During operations in the eye, sections 306 and 320 may becomecontaminated. As a result, they may be made detachable from the rest ofthe mechanism so that they can be discarded after a procedure, asopposed to being sterilized. At the same time the work tip 14 with theattached sterile sheet 315 would be disposed. The mechanism 300 ispreferably made of plastic material to save on costs.

FIG. 12A shows a work tip with a flared part 146 in solid line. Sleeve320 is shown in cross section surrounding it. It will be noted that thework tip has a small opening 150 near its distal end. Further, thesleeve 320 has a hole 332 at a distance from its distal end and twohinged semicircular portions 322 at its distal end. In the positionshown in FIG. 12A the sleeve 320 is in an extended position so that theflared end 146 of the work tip pushes the hinged portions of the sleeveaside. See the schematic view of FIG. 12C which shows that the curvedparts of the semicircular portions 322 are fastened to the sleeve by aspring 321. In this position normal phacoemulsification can take placein which cataract tissue impacted by ultrasonic vibration is aspiratedinto opening 143 of flared portion 146.

When it is time for cleanup, the surgeon can use the finger portion 302to slide or retract the sleeve. When this is done, the hingedsemicircular portions 322 close off the work tip opening as shown inFIGS. 12B and 12D. The sleeve 320 has an opening 330 in it and asmentioned above the flared part has a lateral opening 150. In theretracted position aspiration fluid is sucked into the lateral opening150. Because in this position the opening 330 and the hole 150 aregenerally aligned as shown in FIG. 12B, opening 330 acts as the I/Aopening during clean up. While the opening 330 is shown with asemicircular shape, it can be provided with any convenient and usefulshape. It can also include a plurality of openings in different patternsand sizes. The surgeon will select the adapter to best meet theconditions that are present during the surgery.

An alternative embodiment of a slidable sleeve 320 that can beconfigured for I/A clean up is shown in FIG. 13A in cross sectionlocated about a work tip with a flared part 146. The sleeve has aproximal part 354 and a distal part 352, with irrigation holes 332located in the proximal part. At least the distal end of the part 352 isin the form of multiple (e.g., 8) segments 350 designed to naturallyfold over the opening 143 of the work tip. Compare FIGS. 13B, 13D and13F. In FIG. 13B the segments are fully retracted. In FIG. 13D thesegments are shown as a twisting closure like the diaphragm of a camera.However, they could alternatively be segments of a hemisphere which arenot quite together (not shown). FIG. 13F show a complete closure wherethe segments are segments of a hemisphere which are fully closed(folded) over the opening 143 in the work tip.

FIG. 13A shows the sleeve 320 in its retracted position. In thatposition the flared end 146 is used in its normal phacoemulsificationfunction. Irrigation fluid can flow and exit conventional sleeve 17, solong as adapter sleeve 320 does not block the flow. Where the sleeve 320is used in place of the end of sleeve 17, the holes 232 in that sleeveprovide irrigation fluid. When the finger portion 302 is pushed forward,the sleeve is caused to extend beyond the flared portion 146 as shown inFIG. 13C. As a result, the segments 350 begin the fold toward each otherpartially closing the opening 143 in flared part 146 as described above.See FIG. 13D.

When sleeve 320 is fully extended, the segments 350 can completely closethe opening 143 in flared part 146 or they may leave a small opening 352that can be used for I/A clean up.

FIG. 14A shows a dual lumen work tip of a type disclosed in the presentinventor's U.S. Published Patent Application No. 2016/0106580 A1, whichis incorporated herein by reference in its entirety. This work tip hastwo tubes 423 and 424 joined together at hub 425 and at various sectionswhere the tubes come in contact with each other. The entire assembly canbe connected with thread 465 to an ultrasonic hand piece. Depending onthe preference of the surgeon, either one of the two tubes or both ofthe tubes can irrigate the surgical site or aspirate tissue and fluidfrom the surgical site. If both tubes aspirate through openings 426 and428 then a separate infusion source needs to be provided. The dual lumentip and hub can be tightened onto the hand piece with a wrench designedto be inserted into opening 475.

In a typical phacoemulsification operation with the work tip of FIG.14A, irrigation fluid is directed to the cataract through tube 424 toopening 428 and ports 460, 480. Tissue is aspirated through opening 426into tube 423. As one aspect of the present invention, I/A clean up canbe improved with this instrument by placing an adapter sleeve 420 overthe distal ends of the tubes 423, 424. This adapter 420 is shown priorto installation in FIG. 14B. The adapter when installed blocks theirrigation and aspiration flow paths of the work tip through openings426, 428, 460 and 480. In their place a plurality of aspiration holes430 are provided in the adapter 420. Also, irrigation is limited to hole432 in the adapter.

With this design, the dual lumen work tip is removed from the eye. Thenthe adapter is placed on the work tip and retained there by any of themethods shown in FIGS. 5B, 6, 7A, 8B, 9B and 10. Finally the work tip isreturned to the eye to complete the I/A clean up. However, the adapter420 can be modified to have a shape like that in FIG. 12 or 13 so thatit can be withdrawn from the distal end during phacoemulsification andextended during the subsequent clean up. During this extension a portionof the sleeve would extend over the openings 426, 428 in the distal endsof the tubes 423, 424 as shown in FIGS. 12 and 13. The extension andretraction of the sleeve 420 can be by way of a mechanism 300 shown inFIG. 11.

While the invention has been shown and described in connection with theremoval of a cataract from the eye of a patient and subsequent I/A cleanup, the apparatus and method may also be used for other types of surgeryin other parts of the body, e.g., the removal of neurological tissue.

Specific features of the invention are shown in one or more of thedrawings for convenience only, as each feature may be combined withother features in accordance with the invention. Alternative embodimentswill be recognized by those skilled in the art and are intended to beincluded within the scope of the claims. Accordingly, the abovedescription should be construed as illustrating and not limiting thescope of the invention. All such obvious changes and modifications arewithin the scope of the appended claims.

1-26. (canceled)
 27. A surgical handpiece comprising: a connecting bodyhaving a distal end; a work tip having a hub at a proximal end and anopen operating end at a distal end thereof, said hub being attached tothe connecting body, an axial channel extending through the work tipfrom the operating end to the hub; a housing containing the connectingbody and at least a portion of the hub; an irrigation sleeve surroundingand spaced from the hub, said sleeve extending to the vicinity of theoperating end of the work tip, said sleeve being in fluid connectionwith an irrigation channel between the inner surface of the sleeve andthe external surface of the work tip which extends to the vicinity ofthe operating end of the work tip for delivery of irrigation fluid tothat area, said irrigation channel being generally concentric with theaxial channel in the hub, and aspiration fluid is withdrawn from theopen operating end of the work tip; a slidable sleeve located closelyabout the distal end of the work tip so that it can be introduced intothe eye of a patient along with the work tip; and a sleeve slidingmechanism that can move the slidable sleeve axially along the work tipdistal end, said sliding mechanism including a finger portion locatedalong the housing of the hand piece and being connected to the slidablesleeve; whereby sliding of the slidable sleeve through action of thesliding mechanism causes the sleeve to reconfigure the openings in thework tip for I/A clean up.
 28. The surgical handpiece of claim 27wherein the irrigation sleeve and the sliding sleeve are one piece. 29.The surgical handpiece of claim 27 further comprising: a small openingis proved near the distal end of the work tip; wherein the slidingsleeve includes an aperture at a distance from its distal end, a holenear the distal end and two hinged semicircular portions at its distalend, wherein curved parts of the semicircular portions are hinged to thesleeve and urged into a closed position by an elastic member, theaperture provides irrigation fluid to a surgical site; whereby, when thesliding sleeve is retracted with respect to the work tip by the slidingmechanism, the flared end of the work tip pushes the hinged portions ofthe sleeve aside and the work tip can be used for phacoemulsification ofcataracts in the eye of a patient; and whereby, when the sliding sleeveis extended with respect to the work tip by the sliding mechanism, thehinged portions of the sleeve close off the work tip opening at theflared portion, the hole in the sliding sleeve and the opening in thework tip align, and the hole and work tip define an aspiration openingduring I/A cleanup of the capsular bag of the eye.
 30. The surgicalhandpiece of claim 29 wherein the hole may have any convenient anduseful shape, maybe in the form of a plurality of openings in differentpatterns and sizes.
 31. The surgical handpiece of claim 27 wherein thesliding sleeve comprises a proximal part and a distal part, withapertures located in the proximal part, at least a distal end of thedistal part is in the form of multiple segments designed to fold into aclosure; whereby, when the sliding sleeve is retracted with respect tothe work tip by the sliding mechanism, the flared end of the work tip isexposed and can be used for phacoemulsification of cataracts in the eyeof a patient; and whereby, when the sliding sleeve is extended withrespect to the work tip by the sliding mechanism, the segments foldtoward each other partially closing the opening in the work tip exceptfor a small space, which defines an aspiration opening during I/Acleanup of the capsular bag of the eye.
 32. An adapter for a surgicalhand piece having a single lumen work tip to convert it toinfusion/aspiration (I/A) cleanup of lens epithelial cells in thecapsular bag of the eye of a patient after phacoemulsification,comprising a sleeve adapted to be joined to the distal end of work tip,said sleeve having a proximal end for attaching the adapter to thedistal end of the work tip, and at least one aspiration hole locatedtoward the distal end of the sleeve; and wherein the sleeve is sized tofit within the opening in the distal end of the work tip, the sleeveincludes at least one protrusion on its exterior surface near its distalend and wherein the work tip has at least one recess in its interiorsurface that engages the sleeve protrusion to hold the adapter on thework tip.
 33. The adapter according to claim 32 wherein the diameter ofthe sleeve with respect to the opening in the distal end is such thatthe adapter becomes press fit in the work tip, and the sleeve furtherincluding a raised portion on its distal end that has the same diameteras the work tip so that the outer surfaces of the work tip and theadapter smoothly join when the adapter is installed on the work tip, theaspiration hole being located in the raised portion of the sleeve.